Diabetes Prevention

Diabetes Prevention

Anne Peters, MD, FACP, CDE (Professor and Director of Clinical Diabetes Programs, USC Keck School of Medicine) gives expert video advice on: Is it possible to prevent type 1 diabetes?; Is it possible to prevent type 2 diabetes?; What environmental factors contribute to diabetes? and more...

Is it possible to prevent type 1 diabetes?

Type 1 diabetes, as far as we know, is not yet preventable. But there's a lot of research that's ongoing to try to find the genetics of type 1 diabetes, and also to try to find ways to prevent it. So it's something that's on the horizon, but unfortunately we have no way to prevent it at present.

Is it possible to prevent type 2 diabetes?

Type 2 diabetes is really preventable. The first thing you have to do is know you're at risk. And really try to figure out not only if you're at risk, but if the people in your family are at risk. The real way to prevent type 2 diabetes sounds simple but it isn't. It means you need to lose weight if you're overweight and exercise. Now, it doesn't mean that you need to become thin. If you need to lose a hundred pounds, you don't have to do that to prevent diabetes. You only really have to lose about fifteen pounds, about seven percent of your body weight. So for a lot of people, that's twelve to twenty pounds. If you lose that weight, and if you keep it off; it will prevent diabetes. Now, in addition you need to exercise, and I don't mean running marathons although that might not be bad. What you really want to do is to exercise for thirty minutes a day, five days a week and we think that walking, for instance, is a very good way of getting exercise. Also, just gently going out, just moving your body, increasing your exercise, and if you can over time increasing the intensity this is perfect. But getting exercise and losing weight prevents diabetes. For a lot of people, that's really hard to do. And everyone's busy and people don't have the time to do it and the really important part is that people don't have the time to maintain it. So a lot of people can lose twenty pounds but keeping that twenty pounds off is the hard part. So a lot of individuals will develop diabetes gradually and there's now ways we can try to use different medications that are actually meant for treating diabetes but if we use them earlier we can prevent diabetes. But my key message is lifestyle. So if you have an overweight fifteen year old and you or someone in your family has type 2 diabetes, the best thing you can do for that kid is to really work with them in terms of helping them choose healthy lunches, giving them breakfast, getting them to do physical activity, making habits young that will last for a lifetime and that's how you prevent diabetes.

Is it possible to prevent the complications of diabetes?

I think that the most of the complications of diabetes are preventable. Unfortunately they are not reversible so if somebody doesn't know that they have diabetes for 10 years they can come to me with the nuances of diabetes onset only they just found out and they already have damage to their eyes, their kidney and their nerves. So first and foremost people need to get diagnosed early. They need to find out what their blood sugars are, they need to see if they are at risk and then if you put people like that under good care and they keep coming back and getting good care, in my experience they really don't get diabetic complications. Now, there may be a little problem here and there, there may be a little damage to the eyes, little damage to the kidneys over 20 – 30 years but in general it's not something the person really notices and if it's treated then you can really deal with that.

Why is type 1 diabetes considered an autoimmune disease?

Type 1 diabetes is an autoimmune disease because it's a disease in which the body makes infection-fighting cells, what we call antibodies, that, by mistake, attack the islet cells, the insulin-producing cells on the pancreas. It is because of that that the body cannot make insulin any further and people get type 1 diabetes.

What is an "autoimmune disease"?

An autoimmune disease means the body makes a mistake. It looks at some normal tissue and says, "That's a foreign invader." So, in the case of diabetes, the body looks at all its cells and says, "There's something wrong here," and tries to kill off the eyelet cells by an autoimmune response, making antibodies. In the case of rheumatoid arthritis the body looks at joint tissue and says, "That's not normal," and the autoimmune response is that the body tries to kill it off. And so an autoimmune disease is really a mistake by the immune system, and that mistake creates a disease.

What environmental factors contribute to diabetes?

There probably are a lot of environmental factors that contribute to causing or triggering Type 1 diabetes but we don't really know what they are. We know that there are certain viruses. There are certain subtypes of Coxsckie viruses, for instance, which we know can cause Type 1 diabetes but most of the time we don't know what caused it. We know something in the environment triggered it, but we really don't have any idea of what that is. Pregnancy can cause <a href="http://www.videojug.com/interview/gestational-diabetes">Gestational Diabetes</a>, but that goes away after the birth. Eventually we will figure it all out but we don't know yet.

Why are people getting type 2 diabetes at a younger age?

People are getting type 2 diabetes at younger ages because we are basically seeing an epidemic of obesity and inactivity in children. So if you think about it, when you see the classic guy in my clinic who is 45, 50 years old - he's got a central ponch. He has got a family history of type 2 and he comes to see me because he has diabetes. He'll tell me very proudly that he played something in college. That he was thinner than his wife when he got married, that he was fit and he is proud of that. And he will say, "I don't know what happened." But we know what happened, you know the kids, house, the mortgage. But we know that he was fit in high school and college. The problem is, is that his son is a couch potato. His son isn't going out and doing anything more than walking to school even if that. His son is spending hours and hours of time doing things that aren't physically active. So we are shifting. So instead of being 50 and becoming fat, people are becoming 10 and becoming fat and that means that this disease is now starting when they are ten, not fifty, which means this epidemic is going to be seen in fifteen year olds, twenty year olds, thirty year olds. And they're going to get heart disease. They are going to get strokes and they are going to get diabetes before they are forty.

Is diabetes just a problem in the USA and other "Western" nations?

Diabetes is an epidemic that's happening around the world. The two leading countries, in terms of developing diabetes, actually turn out to be India and China. The reason that is, because, they now have an influx of western dollars. Their societies are doing well, people aren't as poor as they once were. The way that I look at this is, maybe, all of those people who survive all of that poverty have these great genes for survival. Those same genes now, when they have food, are causing them to store food in their center and cause them to go on to get diabetes. In fact, in Asian individuals, the amount of fat they have to have, in their center is much, much less than in someone, say, from East Los Angeles where their guts are much bigger. So, very low levels of obesity or being over weight, Asian individuals develop diabetes. I think they are very good at surviving famine but, now their environment has changed. At least for many of them they are not as poor, they have more food, they have more fast food, they have fast food all over the world and people are getting diabetes.